Provider Demographics
NPI:1558571901
Name:MARIAN D LALEVEE, MS RD CDE LDN LLC
Entity Type:Organization
Organization Name:MARIAN D LALEVEE, MS RD CDE LDN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:LALEVEE
Authorized Official - Suffix:
Authorized Official - Credentials:MS RD CDE LDN LLC
Authorized Official - Phone:508-945-3897
Mailing Address - Street 1:39 WONKAPIT WAY
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02633-1258
Mailing Address - Country:US
Mailing Address - Phone:508-945-3897
Mailing Address - Fax:508-945-1768
Practice Address - Street 1:537 ROUTE 28
Practice Address - Street 2:PORT CENTRE BLDG., SUITE 2 G
Practice Address - City:HARWICH PORT
Practice Address - State:MA
Practice Address - Zip Code:02646-1894
Practice Address - Country:US
Practice Address - Phone:508-945-3897
Practice Address - Fax:508-945-1768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA780133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP47516Medicare UPIN
MAMT0080Medicare PIN